Comparison of Disc Diffusion, Broth Microdilution and Modified Hodge Test Susceptibility Testing Of Escherichia coli Isolates to Beta-Lactam Antibiotics

ABSTRACT         Background and Objective: One of the main tasks of clinical microbiology laboratories is to determine antibiotic resistance profiles in common pathogens and ensure the selection of effective antibiotics for certain infections. The aim of this study was to compare the methods of disk diffusion, broth microdilution and modified Hodge test in Escherichia coli isolates from urinary tract infection and diarrhea for susceptibility testing against beta-lactam antibiotics in Kerman, Iran.         Methods: In this study, 432 E. coli isolates were collected from diarrhea (216 isolates) and urinary tract infection samples (216 isolates). The antibiotic susceptibility testing methods of disk diffusion, broth microdilution and modified Hodge test were performed according to the Clinical and Laboratory Standards Institute guidelines.       Results: The findings of disk diffusion method showed that resistance to cefotaxime, ceftazidime, aztreonam, cefepime and imipenem was 51.15%, 30.55%, 24.30%, 15.27% and 1.85%, respectively. In the disk diffusion test, 51.15% of the isolates were resistant to at least one antibiotic, all of which were later evaluated by the broth microdilution method. Moreover, 52.94%, 17.19%, 13.12% and 0.90% of the isolates were resistant to cefotaxime, ceftazidime, cefepime and imipenem, respectively. All of the isolates were evaluated for the production of carbapenemase enzyme by the modified Hodge test and none of the isolates were found as positive.        Conclusion: This study shows that performing carbapenem tests is very challenging, and laboratories are recommended to use secondary and independent antibiotic susceptibility tests such as modified Hodge test to confirm the carbapenem-resistant results.